Man takes his elderly, ill parents overseas for lower bills

PONDICHERRY, India -- After three years of caring for his increasingly frail
mother and father in their Florida retirement home, Steve Herzfeld was
exhausted and faced with spending his family's last resources to put the couple in a
cheap nursing home. So he made what he saw as the only sensible decision: He
outsourced his parents to India.

Today his 89-year-old mother, Frances, who suffers from advanced Parkinson's
disease, gets daily massages, physical therapy and 24-hour help getting to the
bathroom, all for about $15 a day. His father, Ernest, 93, an Alzheimer's
patient, has a full-time personal assistant and a cook who has won him over to a
vegetarian diet healthy enough that he no longer needs his cholesterol
medication.

Best of all, the plentiful drugs the couple require cost less than 20 percent
of what they do at home, and salaries for their six-person staff are so cheap
that the pair now bank $1,000 a month of their $3,000 Social Security
payment. They aim to use the savings as an emergency fund, or to pay for airline
tickets if family members want to visit.

"I wouldn't say it's a solution for everybody, but I consider it the best
solution to our problem," said Herzfeld, 56, a management expert who made the
move to India with his parents, and now, as "care manager rather than the actual
worker" has time for things like bike rides to the grocery and strolls in the
botanical gardens with his father.

With the cost of nursing homes, home nurses and medications painfully high in
the United States, the elderly and their caregivers have long looked abroad
for better solutions. Many families now drive regularly to Mexico or Canada to
buy cheaper drugs, or hire recent immigrants -- some of them undocumented --
to help them look after frail parents. A growing number of aging couples have
bought retirement homes in Mexico, where help is cheap and Medicare-funded
health care just a quick drive across the border.

Herzfeld never thought he'd be headed abroad, too. When his mother broke a
hip in 2004, he drove down to their home in Pompano Beach, Fla., from his home
in North Carolina, figuring he'd stay a while and help his parents get back on
their feet. But like so many other caregivers, three years later he found
himself still on the couch in his parents' spare bedroom, wondering where his life
had gone and how he was going to find the energy to go on.

"I started to see him breaking down after three years, working 24 hours a
day," remembers longtime friend Eric Shaffer, who runs an international software
design firm with offices around the world, including one in Pondicherry, a
former French colony on India's southern coast. "He was in a chess game with no
move. Nothing was good."

At wit's end, Herzfeld began investigating nursing homes but found that the
$6,600-a-month cost at the cheapest one he could find near family members would
quickly bankrupt his parents. An uncle offered financial help, but Herzfeld's
father refused to take what he called "welfare" from his family or from the
government, which would have assumed the cost of his nursing home care when his
own money ran out.

Herzfeld was also hesitant. "I've seen nursing homes, and it's a hell of a
way to end your life," he said. "I wouldn't want someone to do that to me."

So when Shaffer one day suggested by phone that Herzfeld consider a move to
India, "I said right away, 'There's an idea!'" he said.

Herzfeld, who is single and a longtime follower of Transcendental Meditation,
had previously spent five years in India, first studying and later teaching
courses on management at an MBA program in Hyderabad. He admired India's
longtime, though recently slipping, respect for the elderly, and he quickly realized
that Pondicherry -- a haven for aging hippies from around the world -- might
just work.

The graceful old town, with its orange-blooming flamboyant trees and coconut
palms, was foreigner-friendly and on the ocean, a big attraction for his
father. The weather was much like Florida's, and many people spoke French, a
language his Swiss-born father was fluent in. Best of all, nursing care and rent
were cheap, and Shaffer was already there, promising to help rent a house and
hire staff. Herzfeld decided to make the move.

Just hours after arriving in India, Herzfeld's jet-lagged father tried to
chase his new Indian personal aide out of the bathroom -- the youth had been
instructed to help him with the toilet -- and fell, cracking his head on the
bathtub. The family spent the first night in the hospital as Ernest was stitched
up.

The three also had a few bouts with India's infamous intestinal bugs as they
adjusted to a new diet, and Ernest broke his nose when he tripped over his
aide -- diligently sleeping just outside the bedroom door -- on a midnight
refrigerator raid.

"It was pretty intense those first weeks," Steve Herzfeld said. "It was
chaos."

Eight months later, however, the family is settled in.

Herzfeld's mother has a daily hourlong session with a physical therapist, who
flexes her stiff legs and gets her up walking briefly with a walker. A nurse,
on duty all day, braids flowers into the old woman's gray hair, massages her
legs and arms, holds her hand while she watches television and feeds her
meals. A massage therapist gives both of the aged Americans a daily full-body
massage, and a cook fixes them simple Indian meals.

Ernest spends much of the day watching cable television in an overstuffed
chair, reading a couple of local English-language papers. Sometimes he catches a
rickshaw to the beach or botanic gardens with his aide or his son.

Asked how he likes India, he says he has seen enough and is "ready for a
change." But he admits to liking the food and speaking French, not to mention the
pretty young sari-clad attendants hovering around him.

The trio have long-term visas -- for Steve Herzfeld, a business permit that
allows him to do accounting work for Shaffer's company -- that will allow them
to stay in the country through 2011.

Other things are still being figured out. The family has put up screens to
keep out mosquitoes carrying the dreaded Chikungunya virus, bought a battery
system to cope with power outages, and Herzfeld has the cell phone number of an
excellent local doctor who makes house calls.

But India, where life expectancy still hovers around 60, lacks many
physicians experienced in gerontology. The family keeps in touch with relatives and
friends back home via e-mail and Internet videophone but hasn't yet persuaded
anybody to visit.

"They still think of India as being on another planet," Herzfeld said,
speaking of family and friends. "It's a step above asking them to come to Baghdad,
but not much."

Every time he looks at the bills -- less than $2,000 a month for food, rent,
utilities, medications, phones and 24-hour staffing -- Herzfeld thinks he's
done the right thing for his parents and himself.